Business Rules Are Everywhere — Part 2: Rules for Legacy Modernization and Entry to New Markets

Summary:
With today's competitive pressures, it is make or break for an enterprise to both acquire and keep customers with either modernized legacy systems or new platforms for doing business.. This month, Jim Sinur, with Paul Hessinger, shares a case study in how a global health insurance company chose thinking in rules™ and BRMS technology to do both.

As the economy has improved and with competitive pressures highlighting antiquated systems — along with the dramatic need to support dynamic, online customer experiences — global enterprises are looking for the "right" technologies and architectures. One might almost hear Bill Maher with one of his "New Rules" bits. But the rules here are not funny. Indeed, it is make or break to both acquire and keep customers with either modernized legacy systems or new platforms for doing business. The following is a case study written by Paul Hessinger of InRule Technology.

Overview

This is a brief summary of how a global health insurance company chose thinking in rules™ and BRMS technology to do both. In a thoughtful approach, an innovative Proof of Concept was undertaken that used CRM and BRMS, along with other technologies such as Azure for cloud-based delivery and operation of systems. Microsoft Consulting Services and BRMS "ROAD" (Rule Oriented Architecture and Application Design/Development/Deployment) experts collaborated with the company's IT team. Simply put, it proved the concept and provided a pro forma architecture for leveraging rules to get decisive results.

British United Provident Assurance (BUPA) Ltd. is based in London. It established a compelling if not visionary program called Vision 2020 that laid out a challenging transformation agenda. It faced the ultimate requirement that a rules-based approach addresses: "Just say no to hard-coded logic." BUPA had legacy systems in its Bupa Health Funding (BHF) business, part of its UK Market unit based in Staines, outside London, that used a number of legacy technologies including an old BRMS. Changing rules in the claims adjudication and processing systems was difficult at best. Starting in early 2014 the system began a migration to a MSFT DYNAMICS CRM-based system (with a dash of salesform.com as well!) for sourcing data.

Legacy Results

A BRMS that puts the logic in the hands of those who know it best is used now to validate claims (aka filter invoices), adjudicate claims (eligibility, pay limits), and provide consumer-focused cost estimating. Business personnel rewrote updated rules, and the initial deployment was completed in five months, processing 45,000 claims per day. Rules provided the ability to aggregate and pinpoint nuances in reimbursement amounts. There is an analytics benefit with more decisive decisions about how logic changes will affect future payouts to customers. By June of 2015 over 50% of the legacy rules had been modernized and migrated from the old rules to new rules, with a rallying cry of both IT and the BRMS vendor: "Friends don't let friends hard code logic."

New Market Results

Vision 2020 also called for entry into new markets. Under the direction of a senior global IT executive, who also carried a title of Business Transformation Director, a partnership was established with the largest bank in Hong Kong. Rule authors in London adjusted core rules for pricing, quoting, and onboarding that allowed for an Azure/Dynamics CRM Online and BRMS portal to cross-sell health insurance in the banks' retail branches when a customer wanted to open a credit card account. The original POC was leveraged as the design starting point. The system went live in less than six months and dramatically accelerated the time in which a new customer was set up with the bank's credit card business and healthcare insurance from BUPA.

And then that system allowed BUPA's first entry into a massive market — China. The bank partnership was extended. Rules were again quickly adapted to the Chinese market, and the system is going live as these words are typed.

BUPA has established the BRMS as its global technology component whenever modernized or new systems would benefit from "new rules" / thinking in rules. Another project is underway in the Kingdom of Saudi Arabia. BUPA Australia built its own comprehensive POC that was done in three weeks, as it now begins a legacy modernization project with far reaching implications for its realization of Vision 2020. By using a better approach to rules, a majority of POC claims were within 10 cents of expected coverage, and rules had queries embedded that were able to execute directly with SQL Server for faster performance.

Net; Net

Proof that thinking in rules can rule for both legacy modernization and for entering new markets with systems that have dynamic, if not complex, logic that is best handled by subject matter experts.

Thinking in rules is a registered trademark of InRule Technology, Inc.

About our Contributor:

Jim Sinur
VP and Research Fellow, Aragon Research

Jim Sinur is an independent consultant and thought leader in applying business process management (BPM) to innovative and intelligent business operations (IBO). His research and areas of personal experience focus on business process innovation, business modeling, business process management technology (BPMT), processes collaboration for knowledge workers, process intelligence/optimization, business policy/rule management (BRMS), and leveraging business applications in processes. Mr. Sinur was critical in creating the first Hype Cycle and Maturity Model, which have become a hallmark of Gartner analysis, along with the Magic Quadrant. He has been active in the rules, data and computing communities, helping shape direction based on practical experience. Mr. Sinur has vertical industry experience on the investment and operational sides of the insurance and financial services.

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